Burrisgolden3785

These coordination bonds are accompanied by intermolecular dispersion interactions with BiPhcentroid distances less then  4.0 Å. In solution the diorganobismuth(iii) halides 2-4 show a broadening of their NMR signals (H-8, H-8' and H-9, H-9' protons of the 2-biphenyl ligand), which is a result of dynamic processes including ligand rotation. For further elucidation of these processes compounds 2, 4 and 7 were studied by temperature-dependent NMR spectroscopy. find more Electronic structure calculations at the density functional theory and DLPNO-coupled cluster level of theory were applied to investigate and quantify the intramolecular London dispersion interactions, in an attempt to distinguish between basic intramolecular interactions and packing effects and to shed light on the dynamic behavior in solution.Here, a palladium-catalyzed new hydrogenative annulation reaction of catechols and nitroarylamines, allowing straightforward access to two classes of novel quinoxaline derivatives, is reported. The reaction proceeds with operational simplicity, an easily available catalyst system, and a broad substrate scope, and without the need for pre-functionalization, which offers the potential for further design of new reductive transformations of renewable resources into value-added products.Medical practice is a noble profession that bears with it critical responsibilities on the practitioner and expectations from the public. Few studies originating from low-income countries like Nepal indicate a greater extent of dissatisfaction in relation to workload, financial and social circumstances among doctors leading to lower Quality of life. In addition, there has been a rise in doctor's migration to developed nations in aspire of better living standards and job satisfaction which has aggravated the already resource-constrained healthcare systems in those countries. This challenges both access and equity in healthcare. There are indications, based on first-hand experiences and the socio-political situation, that Quality of Life may be alarmingly poor among doctors working in Nepal. The first step towards a comprehensive effort to addressing this issue would be to carry out researches on doctors to gauge the scale and dimensions of the issue.Septic arthritis of the knee is rare in adults. This leads to difficulty in making early diagnosis that invariably leads to delayed treatment with consequent destruction of the joint. link2 The delay in diagnosis is largely attributed to absence of clinical signs of flagrant infection. Reported are three adult patients who presented with painful swollen knee and inability to walk few weeks after intra-articular injection for osteoarthritis. This paper discusses the cases in which the difficulties in the early diagnosis of septic arthritis of knee in adults led to the development of osteomyelitis.Intradural spinal epidermoid cysts are rare, benign lesions either acquired from trauma, surgery, lumbar puncture or arise as congenital lesions, particularly associated with spinal dysraphism. Epidermoid cyst arising from the spine with expansile destruction of vertebrae has not been reported yet in the literature. We report a case of 36-years male presented with history of fall 8 years back with progressive symptoms of lower back pain, weakness of left lower limb and bladder/bowel incontinence. Computed tomography revealed large lytic expansile, midline sacral vertebral lesion with soft tissue component and multiple calcific foci. Magnetic resonance imaging demonstrated large non-enhancing heterogeneous mass showing restricted diffusion on diffusion weighted images. The patient underwent biopsy confirming the diagnosis of an epidermoid cyst. The possibility of an epidermoid tumor should be kept in the differential diagnosis in patients presenting with post-traumatic sacral mass.Eosinophilic cholecystitis is a rare post-cholecystectomy inflammatory histopathological condition characterized by more than 90% eosinophilic infiltrate in the gallbladder. We present a case of 27-year female presented with abdominal pain, fever, jaundice, altered mental status, shock, leucocytosis, deranged liver function test, and peripheral blood eosinophilia. The patient underwent cholecystectomy and common bile duct exploration. She developed adult respiratory distress syndrome and hospital-acquired pneumonia. From this, we want to emphasize that eosinophilic cholecystitis and cholangiopathy should be a differential diagnosis in patients presenting with allergy, peripheral eosinophilia, obstructive jaundice that are planned to undergo cholecystectomy that will have early critical care intervention.Thanatophoric skeletal dysplasiais the most lethal, rare, sporadic birth defect due to de novo mutation in the fibroblast growth factor receptor-3. Clinically this is characterized by shortening of the limbs (micromelia), small conical thorax, flat vertebral bodies and macrocephaly at birth. We encountered a similar case with ultrasonographic findings suggestive of Thanatophoric Skeletal Dysplasia which resulted in the death of the baby within an hour of birth. Almost all cases of this condition have been reported to have died interuterinally or a few days after birth.Dermatomyositis is an idiopathic muscle disease characterized by proximal muscle weakness, raised muscle enzymes, characteristic changes in electromyography and typical skin rash and biopsy findings. Dermatological features like Gottron's sign and papules are considered as pathognomonic for dermatomyositis. Panniculitis is one of the rare findings in dermatomyositis. Here, we report a case of dermatomyositis in 37 years old female who presented with only panniculitis and the diagnosis was delayed by more than a year.Potter sequence is a rare congenital malformation that primarily affects male fetuses and is characterized by pulmonary hypoplasia, skeletal malformation, and kidney abnormalities. The pressure of the uterine wall due to oligohydramnios leads to an unusual facial appearance, abnormal limbsor limbs in abnormal positions or contractures. The fetus generally dies soon after birth due to respiratory insufficiency. We presented a male baby of 35 wks gestation with birth weight 1200gms delivered by primi mother. She had severe oligohydramnios and virtually there was no liquor during birth. The baby had severe perinatal depression at birth requiring resuscitation. Multiple congenital anomalies like absence of left eye, congenital cataract on the right eye, right-sided choanal atresia, micrognathia, low set ears, beaked nose, bilateral clubbed foot with hip deformity were noted. After 2 hours of life,baby developed fast breathing and cyanosis and died due to respiratory failure.Calcifying epithelial odontogenic tumor is a rare benign odontogenic tumor which accounts for approximately 1% of the entire odontogenic tumor. It was firstly described by Pindborg, and thus, is also referred to as the "Pindborg tumor". Histologically, Pindborg tumor consists of three distinct histological compo-nents sheets of polyhedral epithelial cells, amyloid like deposits, and calcifications. This case report describes a case of Calcifying epithelial odontogenic tumor in 26 years old female patient presented with the swelling in right posterior region of mandible. Taking into account of the aggressive nature of the lesion segmental resection of the mandible followed by reconstruction was planned for treatment. This case report highlights the importance of appropriate clinical, radiographical and histological correlation for the correct diagnosis and treatment of Pindborg tumor.Xanthomas are subcutaneous lipid deposits containing macrophages loaded with cholesterol and cholesterol esters. Although quite common in adults, xanthomas in pediatric population are infrequent and when present, may represent a cutaneous manifestation of underlying lipoprotein disorders which most often are familial. We report a case of an eleven-year-old female child, with multiple eruptive xanthomas of skin since two years of age, a positive family history and deranged lipid profile consistent with possible familial hypercholesterolemia.INTRODUCTION Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. METHODS This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital, eastern Nepal. link3 The sample enrollment process was consecutively who were admitted under medical ward and intensive care unit. Diagnosis was established serologically with positive test of IgM antibodies against scrub typhus using immuno-chromatography. Operational definitions for organ system dysfunction were based upon simple available clinic laboratory profiles and imaging. Collected data were entered in Microsoft Excel 2007 and converted it into Statistical Package for Social Science 11.5 Version for statistical analysis. RESULTS A total of 47 patients were analyzed during this study. Diagnosis of scrub typhus was more common 17 (36.17%) in age group of (40-60 years) with female predominance 32 (68.08%). Most patients (70.15%) were of above 40 years. Fever 47 (100%), asthenia 40 (85.10%), generalized body-ache 41 (87.23%), anorexia 46 (97.87%) and headache 39 (82.97%) were present in most of our patients at sometime during their illness. Respiratory dysfunction was the commonest 37 (78.72%) system dysfunction followed by renal 30 (63.82%) and hepatic 20 (42.55%) impairment. Fortunately no deaths occurred. CONCLUSIONS Scrub typhus occurred more commonly in elderly female patients. Early empirical treatment may prevent mortality. Large studies involving whole country is needed to see real scenario of disease in this setting.INTRODUCTION Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion. METHODS This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean ±SD and frequency (percentage). RESULTS A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%). Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma. Procedure related mortality and major complications were nil. Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively. CONCLUSIONS Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.